TO FIND OUT UTILITY AND SCOPE OFPHATAK REPERTORY

IN CHILDREN RESPIRATORY DISEASES

A STUDY BY

Dr. KAVITA SHARMAChief Medical Officer

Department of AYUSH

Keshavpuram Dispensary

Introduction Repertory and Materia Medica are twin pillars for

successful practice of homoeopathy.

Proficiency in the art of prescribing in Homoeopathy can be achieved by constant and diligent study of the remedies given in Materia Medica, with reference to their place value given in the repertory.

To find a suitable medicine in the shortest possible time, busy practitioners and sincere physicians are not satisfied with one type of repertory.

Introduction Different types of repertories were prepared to

help finding the medicines by various methods.

Phatak Repertory is one such repertory.

It is an alphabetical clinical repertory and a concise reference work.

Dr. Phatak has included rubrics duly verified by him and remedies for a particular rubric have been reduced to minimum by a careful selection.

Introduction Respiratory diseases are the most common

problem in tropical countries like India.

Acute respiratory infections itself constitute 22 to 66 percent of all paediatric outpatient cases.

Common cold, Pharyngitis, Bronchitis and Asthma are the common respiratory illnesses seen in children.

Incidence is more due to increasing air pollution

Introduction Childhood is the most appropriate stage which

presents the characteristics of different miasm in a more pronounced and clear way.

It is the most useful period for treatment on constitutional level.

In children, objective and pathological symptoms are more reliable than those given by the patient.

Introduction

The case which has less number of mental generals but more pathological symptoms can be processed through Phatak’s Repertory.

The present study is undertaken to throw light on utility and scope of Phatak’s Repertory in the treatment of Respiratory diseases of children.

Aim To study scope and limitations of Phatak’s

Repertory in the treatment of Children’s Respiratory Diseases.

To study efficacy of homoeopathic medicines in Children’s Respiratory Diseases selected with Phatak’s Repertory.

To study Children’s Respiratory Diseases from nosological and miasmatic point of view.

Review of Literature The selection of the similimum from the materia medica

always demands some way of differentiating or sorting out similar looking drugs and repertorization is one such comprehensive, scientific and precise tool of accomplishing this task.

To quote Dr. P. Schmidt, “No one can know everything and that is why in all honesty one must admit that no conscientious homoeopathic doctor can practice homoeopathy in a serious and really scientific way without a repertory. To meet the challenge of the exploding Materia Medica, the homoeopathic repertory was born”

Review of Literature

As per Dr. Phatak, prescribing in homoeopathy is both art and science. Good case taking, sound knowledge of materia medica and skillful use of the reference books are the three requisites.

There are more than 200 repertories available and every repertory has its own characteristic feature, importance and utility and the search for an ideal and complete repertory will go on unabated in future.

Review of Literature

‘A concise repertory of the Homoeopathic Medicines’ by Dr. S.R. Phatak is an alphabetical repertory based on Boger synoptic key.

Its first edition was published in September 1963.

Inclusion of rubrics and medicines has either come from his own clinical experiences and observations or there is a strong justification provided for it by authorities like Dr. Boger,

Dr. Kent, Dr. Clarke etc.

Review of Literature

This repertory does not replace exhaustive repertories like Kent or Boenninghausen, the arrangement of rubrics in Phatak’s Repertory makes it useful in most of the daily routine cases.

The headings including Mentals, Physical Generals, Modalities, organs and their subparts along with physiological and pathological conditions are arranged according to their alphabetical orders.

Review of Literature

For major organs, rubrics on locations are arranged first, followed by complaints and sensations. Among the locations, the right side is followed by the left.

Dr. Phatak has garnered all useful modalities and concomitants from different standard repertories and has included them in this book.

For all the general modalities the word Aggravation and Amelioration are printed in capitals as AGG and AMEL and for particular modalities agg and amel in roman have been printed.

Review of Literature Rubrics like blood pressure, bronchitis,

bronchiectasis, colitis mucous etc are very useful nosological rubrics.

Cross references are given wherever necessary.

Three varieties of typography has been used to indicate the gradation of remedies in a particular rubric – Capitals, Italics, Ordinary

Total number of medicines in the fourth edition is 451 and the number of main rubrics is 1971.

Review of LiteratureDr. Phatak had also contributed many other books in Homoeopathy.

Other Literary Contribution of Dr. Phatak 1. Materia Medica of Homoeopathic Medicines

by Dr. S.R. Phatak (English) – July 1977 2. Repertory of Biochemic Remedies (English) 3. Homoeopathic Materia Medica (Marathi). 4. Repertory of Homoeopathic Medicines

(Marathi).

Review of Literature

RESPIRATORY DISEASES IN CHILDREN

A child comes to this world as an individual and brings with it a stock of inherited miasms from its parents and faces the exacerbation of acute miasm excited by numerous climatic conditions.

Acute Respiratory infections are the most common illnesses in childhood comprising 50% of all illnesses in children under 5 yrs and 30% in children of 5-12 yrs.

Review of Literature

There are seven main clinical categories of resp. infec. 1. Upper Respiratory Infection

Acute Rhinitis, Acute Pharyngitis and Tonsillitis

Acute laryngitis, Adenoids, Sinusitis 2. Nasal Polyp and Epistaxis 3. Laryngotracheobronchitis 4. Bronchiolitis 5. Acute Bronchitis 6. Bronchial Asthma 7. Pneumonia

Material and Methods

The present study was conducted in Homoeopathic Unit of Shakurpur Delhi Government Dispensary

The cases were collected from O.P.D. during period of 12 months from 2009 – 10.

30 cases of acute and chronic respiratory disease were treated during this period of study.

Inclusion criteria The children belonging to different age group, of

both sexes, different socioeconomic status.

Different types of respiratory disease were randomly selected for the study.

The different age categories are as follows:

a. Infants – 0-1 year

b. Toddler – 1-3 year

c. Preschool – 3-5 year

d. School going – 6-12 year

Exclusion criteria a. Tuberculosis

b. Foreign body aspiration

c. Pulmonary oedema

d. Bronchiectasis and Lung abscess

e. Complicated cases and cases requiring hospitalization

Methodology Proper Case taking was done according to

prescribed homoeopathic case record format.

In all the cases family history and past history was recorded to evaluate the hereditary tendency and genetic involvement.

The cases were analyzed, evaluated and later repertorized according to computer version of Dr. Phatak’s Repertory in Radar 10.0 software

Methodology All the patients were advised to report at regular

intervals and this interval varied according to the severity of the symptoms and presentation.

Chronic cases were received once in 7, 15 days and the follow up continued for 6 months to one year.

Acute cases were reviewed once in 3 and 7 days and follow up continued for 1 to 3 weeks.

Assessment of resultsThe following parameters were fixed according to the

type of response obtained after the treatment.

(a) Recovered - Feeling of Mental and Physical well being with disappearance of all the Symptoms and Signs.

(b) Improved - Disappearance of Symptoms during treatment as long as medicine was continued.

(c) Not Improved - No relief of Symptoms and Signs even after sufficient period of treatment.

Observations and Analysis Distribution of cases in relation with age

0

2

4

6

8

10

12

14

Nu

mb

er

of

Ca

se

s

Infants Toddler Preschool School going

Age Category

Observations and AnalysisDistribution of cases in relation with sex incidence

1614

Male Female

Observations and AnalysisDistribution of cases in relation with

socioeconomic status

0

2

4

6

8

10

12

14

Nu

mb

er

of

Ca

se

s

Poor Average Affluent

Socioeconomic Status

Observations and AnalysisDistribution of cases in relation with the

family history

0

2

4

6

8

10

12

14

16

Nu

mb

er

of

Cases

Respiratory Disease

Any otherMiasmaticDisease

No otherMiasmaticDisease

Family History

Observations and AnalysisDistribution of cases in relation with the

disease diagnosis

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Nu

mb

er

of

Ca

se

s

Disease Diagnosis

Observations and AnalysisDistribution of cases in relation with the

nature of disease

8

22

Acute Chronic

Observations and AnalysisDistribution of cases in relation with the

results of treatment

0

2

4

6

8

10

12

14

16

Nu

mb

er

of

Ca

se

s

Recovered Improved Not Improved

Results of Treatment

Chronic

Acute

Discussion

30 cases of ‘Respiratory diseases in children’ were treated from holistic point of view with different homoeopathic medicines.

Study of children from its birth situation to its growth, temperament, constitution, miasmatic and nosological aspect was helpful in deriving the antimiasmatic and curative remedies.

Discussion The majority of cases observed in this study are in

the school going age group (6-12 yr).

As regards to the socioeconomic status, it was observed that 46.6% cases are of average status

Family history of respiratory disease was found in

about 36.6% of cases

Family history of some miasmatic disease was found in about 50% of cases

Discussion In this study, I found a definite link of respiratory

disease to the family history especially in chronic cases like asthma, allergic rhinitis, bronchitis.

In the light of Hahnemann’s miasmatic theory, various chronic respiratory diseases in children could be linked to many deep seated chronic diseases like dermatitis, asthma, rheumatism, tuberculosis etc. and other miasmatic diseases in the family history.

Discussion Along with proper case taking, physician’s

observation is very important in children.

Symptoms with regard to body language, facial expression should be taken as objective mental symptoms and rank them high in analysis.

Pathological generals are well represented in Phatak’s Repertory and I found them very useful in prescribing.

Discussion This Repertory helps the physician in selection of

the Similimum where Causation, Time, Modalities, Aggravating, Ameliorating factors, Pathological generals are available.

Dr. Phatak has given due importance to General Modalities, Time of expression and Clinical Rubrics in the Repertory which are very useful in prescribing.

Discussion The assessment of results - 53.3% cases

recovered, 30% cases improved and in 16.6% cases no improvement was seen.

In this study the repertorization of cases and selection of medicine was done through Phatak’s repertory which was found to be useful.

The results as obtained in the observation confirm the utility of Phatak’s repertory in paediatric respiratory patients.

ConclusionIn this particular study, following conclusions were drawn

• There are significant mental symptoms including body language in Phatak’s Repertory and were used.

• Modalities and Causation are well represented in this repertory and were helpful in selection of the similimum.

• Pathological general were given importance in few cases and helped in selecting the similimum.

• Antimiasmatic drugs are well represented and are found to be useful in chronic cases.

• This repertory is a key tool for the selection of similimum in the shortest possible time.

ConclusionFew limitations of Phatak’s repertory were also found during this study :

• Number of Remedies and Rubrics are less when compared to other Repertories.

• Rubrics without any medicine given as cross reference are of little significance.

Conclusion

Even though Dr. PHATAK’S REPERTORY is a concise repertory, it is unique in that it is based on his well documented clinical experience.

In this study, Phatak’s Repertory is found to be very much beneficial in finding out the similimum in paediatric cases in the shortest possible time with less labour.

Bibliography Banerjea S.K.: Miasmatic Diagnosis, B. Jain

Publishers Pvt. Limited, New Delhi, Revised Edition 2003.

Boenninghausen: “Lesser Writing”, B. Jain Publishers Pvt. Limited, New Delhi, Translated by T.L. Bradford, Indian Edition, Reprint 2007.

Boger C.M. : A Synoptic Key to the Materia Medica, B. Jain Publishers Pvt. Limited, New Delhi, Fifth Edition, Reprint 2006.

Boger C.M. : Boenninghausen’s Characteristics Materia Medica and Repertory, B. Jain Publishers Pvt. Limited, New Delhi, Third Edition, Reprint 1996.

Bibliography

Boger C.M.: “Studies in the Philosophy of Healing”, Roy and Company, Calcutta, Second Edition 1979.

Ghai O.P.: Ghai Essential Paediatrics, Delhi, Dr. O.P. Ghai Publications, 6th Edition, Reprint 2008.

Jolly H.: Diseases of children, The English book society and Blackwell scientific publications, Oxford, London, Third Edition, Reprint 1978.

Kent J.T. : Repertory of the Homoeopathic Materia Medica, B. Jain Publishers Pvt. Limited, New Delhi, Sixth American Edition, Enriched Indian Edition 2006.

Bibliography Kishore J.: “Evolution of Repertories and

Repertorisation”, Kishore cards Publications, New Delhi, First Edition 1988.

Master Farokh J.: Clinical observations of children remedies, B. Jain Publishers Pvt. Limited, New Delhi, First Indian Edition 2010.

Nayak C., Khurana A., Chugh S., Sachdeva J.: Handbook on homoeopathy for mother & child care, Central Council for Research in Homoeopathy, New Delhi, 2008.

Bibliography Phatak S. R.: Concise Repertory of Homoeopathic

Medicines, B. Jain Publishers Pvt. Limited, New Delhi, Fourth Edition, Reprint 2009.

Phatak S. R.: Materia Medica of Homoeopathic Medicines, B. Jain Publishers Pvt. Limited, New Delhi, Second Revised and Enlarged Edition 1999.

Rastogi D.P.: An Overview of Repertories, B. Jain Publishers Pvt. Ltd, New Delhi, Second Edition 2008.

Tiwari S.K.: Essentials of Repertorization, B. Jain Publishers Pvt. Limited, New Delhi, Fourth Edition, Reprint 2008.

Website : www.similima.com

S.No Age Sex Religion Socioeconomic status Family History Treatment taken before

Diagnosis Nature of disease

Medicine Given Result

1 7 M Mu P RD A Epistaxis C Calc carb R

2 6 F H AF RD A Asthma C Puls R

3 4½ F H AV NS NT A. Laryngitis A Spongia R

4 10 M Mu AV MD A All .Rhinitis C Sulphur R

5 4 M H AV MD A C. Tonsilitis C Bar carb R

6 12 F H AF MD Ho Sinusitis C Silicea I

7 7 F H AF MD A Nasal Polyp C Phos R

8 8 F Mu AV NS NT A. Tonsilitis A Hep Sulp R

9 10 F Mu AV RD A Asthma C Lachesis R

10 4 F H AF MD A Adenoids C Calc carb I

11 5 M H AV RD Ay A.Bronchitis A Bryonia R

12 5 F H AV MD Ho C.Tonsilitis C Nat mur R

13 4½ F Mu P MD A Epistaxis C Merc sol R

14 5 M Mu P MD NT A. Tonsilitis A Bell R

15 10 M H AF RD A Adenoids C Medorr NI

MASTER CHART OF CASE RECORDS

16 9 M Mu AV RD A All .Rhinitis C Silicea R

17 5 M S AF MD A C. Tonsilitis C Lyco I

18 1½ F Mu P NS NT A. Phryngitis A Puls NI

19 7 M Mu AV RD A Asthma C Ars Alb I

20 1 F H AV MD NT A.Rhinitis A Merc sol R

21 5 M H AV MD A Adenoids C Thuja I

22 11 F H AV MD Ho All .Rhinitis C Nat mur I

23 2 M Mu P RD Ay A.Bronchitis A Chamo R

24 11 M H AF MD A Sinusitis C Phos I

25 8 M H P MD A Epistaxis C Acid nit I

26 7 F Mu P RD Ay Asthma C Psorinum NI

27 3 F S AF NS NT A. Rhinitis A Rhustox R

28 5 M H AF RD A Adenoids C Tub NI

29 6 M H AV MD A C. Tonsilitis C Nux vom I

30 5 M H AV RD Ho Asthma C Lyco NI